Before leaving the program, she outlined the situations that might be associated with relapse and developed a plan for action that included returning periodically for the drop-in groups for reinforcement. She also signed up for a SmokeEnders group to start after the program ended.54

Six months after the program, there were significantly lower levels of psychological distress and higher levels of positive coping methods in comparison to patients who did not have the program. There were also significant increases in the percentage of NK cells and in their functional effectiveness (cytotoxic activity).55

Increasing Survival Time in Malignant Melanoma. The patients who participated in the above study were followed for six years. A startling difference in death rates between the two groups was found. Of those who were in the control group (no group therapy), thirteen of thirty-four had a recurrence of cancer during the six years and ten died. For those who had the group program, only seven of thirty-four had recurrences and only three died.56

Increasing Survival Time in Breast Cancer. A ten-year controlled study was conducted with eighty-six women with metastatic breast cancer. Those who had a year of weekly group sessions had nearly double the survival time of those who did not have the group (averaging thirty-six months versus eighteen months). The group provided self-hypnosis and a form of therapy called "supportive-expressive therapy."57

Cost-Effectiveness

Aside from the medical and psychological benefits, one of the most important contributions of mind/body medicine is in reducing the costs of health care by reducing the utilization rates of expensive inpatient and outpatient services.

Dr. Elizabeth Devine of the University of Wisconsin School of Nursing in Milwaukee conducted an analysis of 191 different scientific studies in which surgery patients were taught simple mind/body techniques. She found an average reduction in the length of hospital stay of 1.5 days (12 percent). This of course translates into enormous savings, considering the cost of a day of hospitalization. Results also included faster recovery from surgery, fewer complications, and reduced postsurgical pains.58

Other studies have found reduced utilization rates for outpatient medical services. For example, in one study 109 chronic pain patients took a ten-session outpatient group mind/body program. A 36-percent reduction in total monthly clinic visits for pain management was found in the first year after the program.59

Another study looked at the medical care utilization rates of two thousand regular practitioners of TM, comparing them with 600,000 other members of the same insurance carrier. For children and young adults the reduction for inpatient services was 50 percent and for older adults it was 69 percent. The reductions for outpatient services were 47 percent for children, 55 percent for young adults, and 74 percent for older adults.

The greatest strengths of mind/body medicine are in stress-related conditions and chronic illnesses. It also has a great deal to offer in terms of relief of the symptoms of acute illnesses as well as relief from the side effects of treatment such as surgery, radiation, or chemotherapy in cancer.

This is obviously a complementary form of medicine rather than a primary treatment for major diseases. However, while it is usually thought of as supportive rather than curative, there are illnesses that do not respond to conventional medical treatment and for which mind/body medicine offers a way of gaining some relief and promoting recovery.

One point of controversy that often arises in this tradition is the question of whether its use implies an assumption that one's illness must have been caused by the mind in the first place. For example, there are those who question whether this approach should be applied to cancer because to use it might suggest that the person brought the cancer upon themselves. This is an unnecessary assumption since the mind/body connection can be exploited regardless of the cause of an illness.

The leading PNI researcher Alastair Cunningham, who holds Ph.D.s in both psychology and immunology, articulates this point well: "Although epidemiological considerations suggest that the contribution of psychological factors to cancer onset is small . . . no upper limit to what can be achieved by psychotherapy is necessarily thereby set: the relative influence of the psyche on outcome may be greatly expanded by such therapy, overriding the usual progression of disease."61

One limitation is that the methods require an ability to sit quietly and in some cases focus the mind on a technique. Some people suffering from extreme symptoms of disease may at times have difficulty following through with a routine of regular practice. Those who do best are able to sustain a regular practice and achieve cumulative benefits over time.

It should also be remembered that while there have been many studies documenting significant effects of mind/body techniques, there are different kinds of significance. Statistical significance means that there is a measurable effect happening, but this does not guarantee that the effect is strong enough to cause tangible medical benefits.

A Walk on the Beach

Heidi, thirty-five, was scheduled for a round of chemotherapy for breast cancer. The treatment was to take place on Friday and she and her husband had tickets to fly to Hawaii on Saturday for a week's vacation.

As is routine, she was called into the treatment center for a blood check on the Monday before to make sure her white cell count had recovered enough from the previous treatment to allow her to qualify for the next one. To her shock, she was told that her white count was only about half what it should be and she would probably have to forego her vacation.

For four days she practiced imagery intensively several times a day, concentrating on raising her white count. She used images of the bone marrow releasing a steady, strong flow of white cells into her bloodstream and spreading throughout her body. She also imagined directing her breath into the bone marrow and thereby nourishing the stem cells (that produce the white cells) so that they could grow and release more white cells.

On that Friday, she went in for another blood test. Her white count had more than doubled. She was able to have the treatment and the next day was able to walk on the beach with her husband.

Clinical significance, on the other hand, means that actual medical benefits have indeed been observed. The studies reporting a major change in the overall course of an illness or even longer survival time in cancer provide the best examples of clinically significant findings.

Hence a person may use mind/body techniques religiously and practice them perfectly with real commitment and still not get the medical benefits they desire. The degree of the contribution will vary from one person to the next, depending in part on the severity of the illness.

When people do not understand these limitations and have unrealistic expectations, they are at risk of feelings of failure, self-blame, depression, or disappointment that may arise when such expected results are not forthcoming. This is called the psychosocial morbidity of mind/body medicine. Patients and practitioners alike must endeavor to keep a realistic perspective on mind/body medicine, not overrating but also not underrating it.

The Practitioner-Patient Relationship

Mind/body techniques are often used in the context of psychotherapy or group therapy. These situations offer the opportunity for addressing other important aspects of coping with an illness. Often it is important to deal with the emotional aspects of an illness before one can comfortably or confidently pursue use of the mind/body techniques.

In this sense, this is a relatively practitioner-dependent tradition. However, the professional is not so much a healer as a teacher. Once the methods are learned, you can use them on your own at home in the form of a daily practice. And of course there are other ways of learning the techniques such as books and tapes. Some highly motivated people are able to develop a fruitful practice without professional guidance, but such guidance is still advised, especially in using such methods with a more serious illness.

The Vital Fluid

Carol Anne was scheduled to undergo a complicated abdominal surgery to remove a cancerous tumor. Her surgeon told her that patients undergoing this procedure typically lose ten to eleven units of blood.

For several days prior to the surgery, Carol Anne practiced a form of imagery in which she pictured her body going through the surgery without losing any blood, the tissues knitting back together smoothly, no complications, and a speedy recovery. She also imagined the look on the surgeon's face when he realized that no blood had been lost.

The day after the surgery, the surgeon came into her room and congratulated her on how well she had come through the ordeal. To his amazement, she had required only one unit of blood. When she told him of her preparations, he smiled and walked out shaking his head.

Evaluating Personal Results

The results of mind/body techniques may be immediately apparent with changes in mood, pain, or physiological state. This is one of the things that is appealing about this tradition. The body gives direct feedback as to the impact of the technique. In fact, the subjective experience is the most important way of evaluating results.

This is consistent with the advice of Carl Simonton, M.D., who first popularized the use of imagery with cancer. Accordingto Simonton, the criterion of successful imagery practice is whether the person feels hopeful, powerful, and optimistic afterdoing it. This is much more important than the details of the images or whether they followed someone else's particular guidelines.62 Research has also confirmed that feeling confident in one's ability to influence his or her health will in itself reduce the degree of stress they feel and have its own health-promoting effects.

Mind/body medicine is usually used in the role of complementary therapy. This means it works alongside other treatment in a supportive way. I like this term because it communicates a cooperative partnership rather than being exclusive of other traditions. In fact, all medical traditions now include within them some attention to mind/body interactions and ways of working with them.

William Collinge, PhD, MPH is a consultant, author, speaker and researcher in the field of integrative health care. He has served as a scientific review panelist for the National Institutes of Health in mind/body......more

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